Medicare Reimbursement for CPT 21557

CPT 21557 is a surgical procedure code (the specific descriptor is proprietary to the AMA and not reproduced here). This page shows the Medicare Physician Fee Schedule (PFS) allowed amount for this code, both nationally and adjusted for your locality, with separate figures for non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$882.45	$882.45
ALASKA* (AK)	$1095.18	$1095.18
ALABAMA (AL)	$799.98	$799.98
ARKANSAS (AR)	$789.90	$789.90
ARIZONA (AZ)	$858.21	$858.21
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$990.31	$990.31
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$1004.13	$1004.13
OXNARD-THOUSAND OAKS-VENTURA (CA)	$910.84	$910.84
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$921.65	$921.65
NAPA (CA)	$956.18	$956.18
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$993.86	$993.86
VALLEJO (CA)	$951.08	$951.08
BAKERSFIELD (CA)	$879.43	$879.43
CHICO (CA)	$870.87	$870.87
FRESNO (CA)	$870.87	$870.87
HANFORD-CORCORAN (CA)	$870.87	$870.87
MADERA (CA)	$870.87	$870.87
MERCED (CA)	$870.87	$870.87
MODESTO (CA)	$870.87	$870.87
REDDING (CA)	$870.87	$870.87
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$904.38	$904.38
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$899.95	$899.95
SALINAS (CA)	$896.36	$896.36
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$1018.62	$1018.62
SANTA CRUZ-WATSONVILLE (CA)	$908.24	$908.24
SANTA ROSA-PETALUMA (CA)	$916.44	$916.44
STOCKTON (CA)	$870.87	$870.87
VISALIA (CA)	$870.87	$870.87
YUBA CITY (CA)	$870.87	$870.87
EL CENTRO (CA)	$871.39	$871.39
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$907.53	$907.53
SAN LUIS OBISPO-PASO ROBLES (CA)	$883.68	$883.68
SANTA MARIA-SANTA BARBARA (CA)	$897.00	$897.00
REST OF CALIFORNIA (CA)	$870.87	$870.87
COLORADO (CO)	$884.46	$884.46
CONNECTICUT (CT)	$936.88	$936.88
DC + MD/VA SUBURBS (DC)	$973.20	$973.20
DELAWARE (DE)	$870.75	$870.75
FORT LAUDERDALE (FL)	$970.53	$970.53
MIAMI (FL)	$1054.01	$1054.01
REST OF FLORIDA (FL)	$921.76	$921.76
ATLANTA (GA)	$909.61	$909.61
REST OF GEORGIA (GA)	$870.28	$870.28
HAWAII, GUAM (HI)	$879.40	$879.40
IOWA (IA)	$794.29	$794.29
IDAHO (ID)	$803.70	$803.70
EAST ST. LOUIS (IL)	$964.29	$964.29
SUBURBAN CHICAGO (IL)	$974.31	$974.31
CHICAGO (IL)	$1022.26	$1022.26
REST OF ILLINOIS (IL)	$915.20	$915.20
INDIANA (IN)	$807.14	$807.14
KANSAS (KS)	$802.16	$802.16
KENTUCKY (KY)	$840.52	$840.52
NEW ORLEANS (LA)	$879.05	$879.05
REST OF LOUISIANA (LA)	$843.81	$843.81
METROPOLITAN BOSTON (MA)	$948.48	$948.48
REST OF MASSACHUSETTS (MA)	$884.77	$884.77
BALTIMORE/SURR. CNTYS (MD)	$936.58	$936.58
REST OF MARYLAND (MD)	$882.28	$882.28
SOUTHERN MAINE (ME)	$841.32	$841.32
REST OF MAINE (ME)	$819.23	$819.23
DETROIT (MI)	$943.51	$943.51
REST OF MICHIGAN (MI)	$869.97	$869.97
MINNESOTA (MN)	$817.73	$817.73
METROPOLITAN ST. LOUIS (MO)	$868.36	$868.36
METROPOLITAN KANSAS CITY (MO)	$861.88	$861.88
REST OF MISSOURI (MO)	$838.63	$838.63
MISSISSIPPI (MS)	$813.84	$813.84
MONTANA** (MT)	$882.24	$882.24
NORTH CAROLINA (NC)	$824.87	$824.87
NORTH DAKOTA** (ND)	$820.55	$820.55
NEBRASKA (NE)	$794.69	$794.69
NEW HAMPSHIRE (NH)	$881.64	$881.64
NORTHERN NJ (NJ)	$967.47	$967.47
REST OF NEW JERSEY (NJ)	$939.18	$939.18
NEW MEXICO (NM)	$878.67	$878.67
NEVADA** (NV)	$865.35	$865.35
MANHATTAN (NY)	$1022.52	$1022.52
NYC SUBURBS/LONG ISLAND (NY)	$1058.81	$1058.81
POUGHKPSIE/N NYC SUBURBS (NY)	$954.25	$954.25
QUEENS (NY)	$1013.48	$1013.48
REST OF NEW YORK (NY)	$836.60	$836.60
OHIO (OH)	$857.37	$857.37
OKLAHOMA (OK)	$827.33	$827.33
PORTLAND (OR)	$896.53	$896.53
REST OF OREGON (OR)	$850.31	$850.31
METROPOLITAN PHILADELPHIA (PA)	$923.43	$923.43
REST OF PENNSYLVANIA (PA)	$852.29	$852.29
PUERTO RICO (PR)	$884.17	$884.17
RHODE ISLAND (RI)	$890.15	$890.15
SOUTH CAROLINA (SC)	$844.18	$844.18
SOUTH DAKOTA** (SD)	$813.26	$813.26
TENNESSEE (TN)	$807.09	$807.09
BRAZORIA (TX)	$860.69	$860.69
DALLAS (TX)	$870.78	$870.78
GALVESTON (TX)	$866.28	$866.28
HOUSTON (TX)	$923.39	$923.39
BEAUMONT (TX)	$848.24	$848.24
FORT WORTH (TX)	$869.16	$869.16
AUSTIN (TX)	$888.81	$888.81
REST OF TEXAS (TX)	$857.15	$857.15
UTAH (UT)	$853.95	$853.95
VIRGINIA (VA)	$846.75	$846.75
VIRGIN ISLANDS (VI)	$884.17	$884.17
VERMONT (VT)	$827.99	$827.99
SEATTLE (KING CNTY) (WA)	$955.03	$955.03
REST OF WASHINGTON (WA)	$879.58	$879.58
WISCONSIN (WI)	$797.82	$797.82
WEST VIRGINIA (WV)	$888.34	$888.34
WYOMING** (WY)	$855.36	$855.36

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 1 unit per patient per day — Date of Service Edit: Clinical. Units above the MUE are denied; some MUEs can be exceeded only with appropriate documentation and modifiers where policy allows.

How the amount is calculated

Medicare's PFS amount is built from three Relative Value Units (RVUs) — physician work, practice expense, and malpractice — each adjusted by Geographic Practice Cost Indices (GPCIs) specific to the locality where the service is billed. The GPCI-adjusted RVUs are summed and multiplied by the annual conversion factor to produce the allowed amount. Because practice expense costs differ depending on whether a service is performed in a facility (e.g., hospital) or non-facility (e.g., office) setting, the practice-expense RVU component — and therefore the total payment — can differ between the two settings. For this code, the practice-expense RVU is currently the same in both settings, so the national facility and non-facility amounts match; locality adjustments may still cause them to diverge in specific areas.

RVUs — work 14.38, practice expense 8.92 (non-facility) / 8.92 (facility), malpractice 3.12 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

This is an estimate only, not a guarantee of payment.
Medicare typically pays 80% of the allowed amount after the annual Part B deductible is met; the patient or secondary payer is responsible for the remainder.
Modifiers, bilateral/multiple procedure rules, sequestration, and annual budget-neutrality adjustments can change the final paid amount.
Local Medicare Administrative Contractor (MAC) policies and coverage determinations may affect whether and how this code is reimbursed.
Always verify current rates and coverage rules directly with your MAC before billing or appealing a claim.

Frequently asked

Why do the facility and non-facility amounts show the same value for this code?

The practice-expense RVU — the component that differs most between settings — is currently identical for both facility and non-facility for this code at the national level, so the two totals match. Locality-specific GPCI adjustments could still cause them to differ in some areas.

Why might the amount I'm paid differ from the figure shown here?

The displayed amount is calculated using national RVUs and the current conversion factor. Your actual payment depends on your locality's GPCIs, any modifiers applied, sequestration, and whether this service is subject to multiple-procedure or other payment adjustments.

Does this amount reflect what the patient will owe?

No. This figure is the Medicare-allowed amount. Patients typically owe 20% coinsurance after meeting the Part B deductible, unless secondary insurance covers the difference.

Where can I find the official rate for my specific location?

Check the CMS Physician Fee Schedule Look-Up Tool or contact your Medicare Administrative Contractor (MAC) for locality-specific, up-to-date figures.

More free billing tools: all Medicare fees · fee calculator · denial code decoder

Estimated Medicare Physician Fee Schedule amount. Medicare generally pays 80% after the deductible; actual amounts vary by locality, modifiers, sequestration, and annual updates. Verify with your MAC.